Emerging role of botulinum toxin in the management of voiding dysfunction

In recent years there has been tremendous excitement over the use of botulinum neurotoxin (BTX) to treat various urethral and bladder dysfunctions. BTX is the most potent, naturally occurring toxin known to mankind. Why, then, would a urologist want to use this agent to poison the bladder or urethral sphincter?

We reviewed the recent literature on the mechanisms underlying the effects of BTX treatment and discuss current use of this agent within the urological community, as well as provide perspective on future targets of BTX. The information was gathered from MEDLINE, abstracts from recent urological meetings and personal experience.

Injection of BTX appears to have a positive therapeutic effect in multiple urological conditions, including detrusor hyperreflexia and detrusor external sphincter dyssynergia, and nonneurogenic conditions such as pelvic floor spasticity, refractory overactive bladder and, possibly, benign prostatic hyperplasia. Interstitial cystitis may even be potentially helped with bladder BTX injection.

Botulinum toxin is a novel and promising treatment for a variety of lower urinary tract dysfunctions. The basic science behind its mechanism of action and physiology, and published clinical results are impressive. However, since application of BTX in the lower urinary tract has not been approved by the Food and Drug Administration, caution should be used until future properly designed, multicenter randomized studies are completed to assess the safety and efficacy of BTX in urological diseases.